From the Guidelines
Treatment for distal clavicle osteolysis should begin with conservative management for 3-6 months, including rest, activity modification, ice therapy, and NSAIDs, with surgical intervention considered if conservative measures fail, as recommended by recent studies 1.
Conservative Management
Conservative management typically includes:
- Rest and activity modification to reduce stress on the affected area
- Ice therapy to reduce pain and inflammation
- NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation
- Physical therapy focusing on rotator cuff strengthening and scapular stabilization exercises, often 2-3 times weekly for 6-8 weeks
- Corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) may provide temporary relief
Surgical Intervention
If conservative measures fail after 6 months, surgical intervention may be necessary, with distal clavicle resection (Mumford procedure) being the most common approach, either open or arthroscopic. This procedure removes 5-10mm of the distal clavicle to eliminate painful bone-on-bone contact.
Recovery and Prevention
Recovery typically requires 2-3 months before returning to full activities, with physical therapy starting 1-2 weeks post-surgery. Distal clavicle osteolysis often results from repetitive microtrauma causing subchondral bone resorption, commonly affecting weightlifters and athletes performing overhead activities. Early intervention with activity modification and proper biomechanics training can prevent progression and potentially avoid surgery, as suggested by studies on shoulder arthroplasties and clavicle fractures 1.
From the Research
Treatment Options for Osteolysis of the Distal Clavicle
- Initial treatment for osteolysis of the distal clavicle typically involves avoidance of provocative maneuvers, modification of weight training techniques, ice massage, and nonsteroidal anti-inflammatory drugs (NSAID) 2, 3, 4
- Activity modification and rehabilitation are the mainstays of the initial treatment, with adjuvant treatments such as injections or surgery considered in refractory cases or certain patient populations 3
- Surgical options, including distal clavicle resection, have provided good results, with arthroscopic resection being a viable option with low morbidity 2, 5
Indications for Surgery
- Point tenderness of the AC joint, evident abnormal signs with AC joint scintigraphy and AC radiographs, lack of response to conservative treatment, and an unwillingness to give up or modify weight training or manual labor are common indications for surgery 2
- Patients with a traumatic etiology may have slightly worse results compared to those with a microtraumatic etiology 5
Diagnostic Approach
- Diagnosis of osteolysis of the distal clavicle typically involves plain radiographs, magnetic resonance imaging, and clinical examination, with symptoms including pain localized to the acromioclavicular joint region and point tenderness over the affected AC joint 2, 6, 4
- Differential diagnosis and diagnostic approach are crucial in identifying osteolysis of the distal clavicle, with consideration of other possible causes of shoulder pain 6, 3